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CMS Releases Its Final Rule Addressing Long-Term Supports and Services (LTSS), including Employment LTSS, Under Managed Care Plans

May 31, 2016

On April 25, 2016, the Centers for Medicare and Medicaid Services (CMS) released a comprehensive Final Rule on Medicaid and Children’s Health Insurance Program (CHIP) managed care programs. The rule is the first major overhaul of the managed care rules in more than a decade and, according to CMS, is designed to deliver “better care and smarter spending” to the millions of people currently enrolled in managed care plans through these two programs. The Final Rule includes requirements for delivery of managed long-term supports and services (MLTSS). Long-term supports and services can include services that directly promote employment, including supported employment and job coaching for transition age youth. They also can include services that enable beneficiaries to work, such as home health care and transportation. 

CMS’ Final Rule requires the States to establish an independent beneficiary support system designed to help managed care beneficiaries navigate the delivery system for their MLTSS. The rule also requires that MLTSS providers use person-centered planning when determining which services they will cover. According to CMS, requiring MLTSS providers to use person-centered planning will ensure that the MLTSS provided are tailored to each beneficiary’s interests, choices, and desire for independence. These changes may significantly improve the variety of different types of LTSS delivered under managed care change and may reduce the risk of “one-size-fits-all” plans. 

The Final Rule also includes improved oversight of MLTSS providers and the provider network. CMS requires ongoing monitoring of MLTSS programs, and the rule sets standards for evaluating the provider networks that offer MLTSS. CMS specifically addresses the issues of provider accessibility and the credentials and qualifications of each provider to deliver MLTSS. 

For more information on the new rule, read: